Maine's Long And Contentious Medicaid Expansion Battle Could Soon Be Over - Or Not

Oct 31, 2017

Maine's governor and the Legislature - actually legislatures - have battled for years over expanding Medicaid under the Affordable Care Act. Next week Maine voters can get into the act. Referendum Question 2 would approve the Medicaid expansion. Maine Public’s State House Bureau Chief Steve Mistler has written a story for Maine Public.org about the history of Medicaid expansion and talks about it with Morning Edition host Irwin Gratz.

GRATZ: Hello Steve.

MISTLER: Good morning.

GRATZ: One of the interesting features of this is that Maine actually did have an expanded Medicaid program long before the Affordable Care Act was even conceived.

MISTLER: Yeah that's right. The state expanded eligibility between 2002 and 2003 so that more low-income Mainers could enroll. It wasn't quite the level of expansion that's offered under the Affordable Care Act, which is what Question 2 is offering, but it was a pretty significant expansion. And it offered, I think, sort of a preview - for some people anyway - what expansion might look like. From the opponents of Question 2’s point of view, the past experience is a good reason to defeat expansion now. They say the state's uninsured rate, which is the primary reason to expand eligibility, was relatively unchanged during early expansion, and they also add that the program caused the slew of budget deficits during the economic downturn. The proponents spin the experience a little bit differently. They say that the uninsured rate was steady during a period where other states saw spikes and people without health coverage. And they also add that the current expansion proposal is much different because the reimbursement rate is much higher.

GRATZ: In 2012 the U.S. Supreme Court upholds key parts of the Affordable Care Act but rules expanded Medicaid eligibility must be an option for states. That led to round one between the governor and the Legislature in 2013. Tell us what happened.

MISTLER: The Democrats, which controlled the entire Legislature at the time, they passed an expansion bill in May of 2013. And the scene that unfolded was really interesting because they had arranged this elaborate press conference in the Hall of Flags at the State House and they planned to, you know, have all the reporters there and the TV cameras there to witness this great victory. Well, Gov. LePage had other ideas, and he basically had his staff hastily assemble a folding table in the Hall of Flags where he took what was, basically, a symbolic version of the bill, put it down on a table, made a few brief remarks and just vetoed it on the spot in front of all these television cameras, and before Democrats could even get there. That scene really was emblematic of how ferocious this fight would be over the next four years.

GRATZ: Let's talk about the arguments for and against. What do proponents say Maine stands to gain by approving expanding Medicaid?

MISTLER: Their big argument for doing this is that it would take care of the “coverage gap.” This is the gap that exists between the people who received subsidies through the Affordable Care Act on the individual market, and the people who qualify for Medicaid, as it stands right now. Seventy-thousand Mainers have fallen into this hole. That's what their primary push is, is that we would shore up this program and it would take care of these 70,000 Mainers that have nowhere to go.

GRATZ: And the opposing arguments?

MISTLER: The opposing arguments are, basically, that these are able-bodied adults. They can work, they can get better employment, and then get employer-based health coverage. Or they can get subsidies off the exchange. And they also keep pointing back to our previous expansion experience, where they viewed Medicaid as a budget buster. And regardless of whether or not the federal government pays 90 percent of the reimbursement to the states, the state will still foot the bill for the rest. And that, in their mind, is something that could cause real budget deficits and problems going forward.

GRATZ: Will the vote be the final word on this?

MISTLER: Well, in the past you could say yes. But the last legislative session has proven that that's not necessarily the case. We saw four ballot initiatives that passed last year that lawmakers turned around, and either changed or repealed, or just delayed implementation.

GRATZ: All right, Steve, thanks very much.

MISTLER: Thanks Irwin.